Last-minute revisions to the multitrillion-dollar economic package pushed President Donald Trump's "big beautiful bill" to House passage during an overnight session Thursday.
Now the Senate gets its hands on the package, which exceeds 1,000 pages, after House committees labored on it for months.
The Senate debate on Medicaid is expected to be just as difficult. Ultra-conservatives and swing-state senators are already looking to make changes to the House version.
House Republicans made one last round of revisions before the bill reached the chamber floor. A focus was speeding up the work requirements in Medicaid to win over those who didn’t believe the bill did enough to curb spending.
The House would cut nearly $700 billion from Medicaid, according to the nonpartisan Congressional Budget Office. It would be the largest cut in the program’s history.
To be eligible for Medicaid, there would be new “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents. The new requirements would begin on Dec. 31, 2026. People would also have to verify their eligibility for the program twice a year, rather than just once.
Republicans are looking to generate savings with new work requirements. But Democrats warn that millions of Americans will lose coverage.
A preliminary estimate from the CBO said the proposals would reduce the number of people with health care by 8.6 million over the decade.
Rep. Judy Chu, D-Calif., said the reduction in Medicaid funding will force states to heavily reduce the amount of money they spend on at-home care for older people and people with disabilities.
Some other details we've learned about the bill:
HSAs, DPC, ICHRAs: The bill includes rules to increase usage of heath savings accounts, a rebranding and expansion of individual coverage health reimbursement arrangements and direct primary care arrangements.
- HSA contribution limits will increase under various proposals. Among them: individuals in Medicare Part A would be able to contribute to an HSA if also in a high-deductible health plan. Also, bronze and catastrophic plans on the Affordable Care Act marketplace would become eligible plans for HSAs.
- An ICHRA allows employers to give employees a tax-free allowance for individual insurance premiums. Under the bill, ICHRAs would become more flexible under the name CHOICE arrangements (Custom Health Option and Individual Care Expense). A tax credit would encourage employers to implement them.
- DPCs are not considered health plans, allowing people with these arrangements to remain HSA-eligible. Also, HSA funds can be used for DPC fees.
Immigrants: The legislation would punish 14 states that offer health coverage to immigrants in the U.S. without authorization. The states, most of them Democratic-led, provide insurance to some low-income immigrants — often children — regardless of legal status.
Trans care: The bill axes Medicaid coverage of all transgender care and prohibit plans offered under ACA exchanges from covering such care as an essential benefit. The bill initially banned coverage of “gender transition procedures” for minors. However, Republican leadership introduced an amendment late Wednesday that struck the words “minors” and “under 18 years of age” from that section, according to The Independent.
Planned Parenthood: The bill bars Planned Parenthood from receiving Medicaid funds, which the organization said could lead to one-third of its health centers closing. The nation’s largest abortion provider offers other health services, including birth control and cancer screening. State Medicaid funds cover abortion in some states.
SNAP: The bill would also reduce spending on the Supplemental Nutrition and Assistance Program by about $267 billion over 10 years. States would shoulder 5% of benefit costs, beginning in fiscal 2028, and 75% of the administrative costs. Currently, states pay none of the benefit and half of the administrative costs.
The measure also alters work requirements to receive SNAP. Adults ages 18-54 who are physically and mentally able and don’t have dependents already must work, volunteer or participate in training programs for at least 80 hours a month, or else be limited to just three months of benefits in a three-year period. The legislation would raise the work requirement to age 65 and extend it to parents without children younger than 7. The bill also would limit the ability to waive work requirements in areas with high unemployment rates.
Information from KFF Health News and Health News Florida's Rick Mayer was used in this report.